Director, Provider Network Operations

PacificSource; Virginia; Hybrid; USD 108,000 - 184,000; Full time

Job summary

PacificSource in Virginia is seeking a senior leader to oversee the Provider Network department's core operations, data, and systems functions. You will guide cross-functional planning to align with enterprise goals and ensure performance across Medicaid, Medicare, and Commercial lines.

You will manage Provider Relations, Credentialing, and Provider Data Management, mentor multi-level teams, and drive improvements in data integrity, contract execution, and provider education while maintaining

Qualifications

• 8+ years in a leadership role overseeing healthcare provider network operations.
• Experience leading Provider Relations, Credentialing, or Provider Data Management.
• Ability to develop and execute strategy within a matrixed organization.
• Knowledge of provider reimbursement methodologies and healthcare data management.

Responsibilities

• Guide strategic initiatives for the Provider Network Operations division and related areas.
• Oversee network setup, data integrity, provider education and service, contract implementation, and provider-related claims and audits.
• Ensure privacy and HIPAA compliance in daily operations and processes.
• Lead cross-department planning and execution to meet department and company KPIs.
• Manage large, multi-level teams and drive performance improvements.

Skills

Accountable leadership

Business & financial acumen

Empowerment

Influential Communications

Situational Leadership

Strategic Planning

Education

Bachelor’s degree in business, health care administration, finance, or related field

Job description

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

This position is accountable for the Provider Network department’s core operational, data, and systems functions. This role will oversee Provider Network divisions including Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability. This position leads both department-specific and cross departmental planning and execution efforts, to maintain high levels of performance in enterprise level and Provider Network level key performance indicators. This position is responsible for all lines of business (Medicaid, Medicare, Commercial) and leads in strong alignment with the company’s strategic plan, vision, and values.

Essential Responsibilities

• Guide strategic initiatives for the Provider Network Operations division, including network setup and maintenance, provider data integrity, provider education and service, contract implementation performance, provider-related claims, provider setup and audits, corrective action plan assessment and closure, and provider directory accuracy improvements.

Supporting Responsibilities

• Assess new and innovative provider payment methodologies for approval and implementation.
• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

Success Profile

• Work Experience: Minimum of 8 years of experience in a leadership role overseeing healthcare provider network operations or related functions required. Experience leading at least two of the following areas is strongly preferred: Provider Relations, Credentialing, and Provider Data Management. Demonstrated experience managing large, multi-level teams and complex operational portfolios. Knowledge of provider reimbursement methodologies, provider network operations, compliance requirements, and healthcare data management required. Experience developing and executing strategy within a matrixed organization preferred.
• Education, Certificates, Licenses: Bachelor’s degree in business, health care administration, finance, or related field required. Candidates with an associate’s degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered.
• Knowledge: Ability to develop and execute strategy Advanced knowledge of provider reimbursement and reimbursement methodologies, provider relations, or provider partnership activities in relevant markets and geography. Ability to lead people in a matrixed organization structure and build high performing teams. Proven collaborative interaction experience with provider leaders.

Competencies

• Authenticity Building Organizational Talent Coaching and Developing Others Compelling Communication Customer Focus Empowerment/Delegation Emotional Intelligence Leading Change Managing Conflict Operational Decision Making Passion for Results

Skills

• Accountable leadership
• Business & financial acumen
• Empowerment
• Influential Communications
• Situational Leadership
• Strategic Planning Compensation Disclaimer

Disclaimer: The wage range provided reflects the full range for this position.

The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within this range. Base Range: $108,468.62 - $184,396.64

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence.

Environment:

Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 15% of the time.

Physical Requirements:

Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer:

Employment remains AT-WILL at all times. This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.